MH4A: Borderline Personality Disorder - Shame

In May I posted about the prejudice, discrimination and stigma faced by those - mainly women - who are diagnosed or even labelled as BPD (Borderline Personality Disorder)

In June the Glasgow Herald carried a a low-key but powerful article on the prejudice experienced by sufferers of BPD - Borderline Personality Disorder.  Today I carry large extracts from the Herald article with additional comments from me.

"Up to 150,000 Scots suffer from Borderline Personality Disorder (BPD), according to the SeeMe campaign. Three-quarters are women.

Yet the term is controversial - viewed by many professionals and patients as a "dead-end" diagnosis. Studies have shown that many psychiatrists and psychiatric nurses view it as untreatable.

This is critically important, as those diagnosed with BPD have a hugely increased suicide risk - 50 times greater than the general population, according to one study."

"Untreatable"; "'dead-end' diagnosis" but, as the article goes on to state, BPD is treatable  There's also a very negative slant to "dead-end". No wonder there's prejudice when so-called professionals don't even know there is a treatment.

"The Mental Welfare Commission in Scotland [MWC] has launched an investigation into the recent suicide of a woman in the Highlands who was alleged to have a personality disorder. But the MWC already believes the situation must change. It carried out an investigation following another case in 2003 where a man with a personality disorder, known as Mr G, was left to languish in prison with an "untreatable" personality disorder.

Mr G was discovered to be suffering from a type of dementia, which had gone untreated. His low mood, suicidal thoughts and inappropriate behaviours were disregarded. Even the fact he was now incontinent hadn't prompted the doctors charged with his care to review their diagnosis, until the commission intervened."

Mr G was labelled, left to rot and the professionals either didn't pay enough attention to see his other symptoms or they didn't care about his diagnosis or they were so fixed on his original diagnosis as to be blind to anything else. Whatever the real reason, these people 'shouldn't be within a million miles of the title 'professional'.

Dr Donald Lyons, director of MWC Scotland, says, "The problem with the diagnosis of personality disorder is that it can be used as a way to exclude people from services. Where somebody has that diagnostic label attached to them, mental health professionals can become blinkered to other mental health problems which are going on with that individual."

It's easy to read these words quickly and not realise just how damning they are!  These 'people' are getting away with behaviours the equivalent of which would be deemed unacceptable in a tradesperson. 

"The trouble is that people who are perceived as behaving in difficult or troublesome ways often get this label - and it might be that they are behaving in a troublesome or difficult way because they are actually ill."

Is it really too much too ask that medics would realise this?  Apparently so.  Patients might be "behaving in difficult or troublesome ways" because no-one in the NHS is listening to them.  

Mr G's case showed clearly that evidence of other conditions was sometimes being overlooked, Lyons says, while a BPD diagnosis also appeared to make it difficult for other agencies to get help for their clients from mental health services.

"When we went to see Mr G in prison, the prison mental health records actually contained the information that we needed to think, wait a minute this isn't right - this diagnosis can't explain everything that's happening with this person.' "In the course of examining the case we interviewed a number of health care, social care, homeless agencies and voluntary sector providers and we were often told of the difficulty they experienced in accessing a mental health service where someone was given a diagnosis of personality disorder."

A key word here is "often".  This means that exclusion from services is not a rare occurrence.  Anecdotally, this is a very common experience. 

Now Lyons believes psychiatrists and those in related professions must change their attitude: "A lot of work has to be done to ensure mental health professionals are aware of the possibilities for treatment. You don't just say, personality disorder - as far as mental health services are concerned, case closed, there's nothing we can do'."

Again this is incredibly damning: "must change their attitude".  We who have suffered or witnessed suffering have been shouting this for ages.

Last year Scotland took a lead within the UK by including BPD in a list of mental health conditions professionals are now obliged to approach in a systematic, comprehensive manner as part of NHS strategies to integrate care.

It is important to realise that treatment must be given only when there is a formal diagnosis of BPD.  If a patient isn't diagnosed as BPD but has a label which professionals know is equivalent to BPD treatment can, and will, be denied. 

Some psychiatrists do accept the need for a new approach.

This means that some do not.  In fact, one could argue that "some" refers to a minority. If this is correct, a majority do NOT accept a new approach is needed.

"Fortunately it is now known there is hope for recovery for BPD sufferers ...... .  Approximately 40% of those diagnosed no longer meet the criteria for BPD after five or six years, and recovery rates can be even higher with effective intervention,...."

So there is treatment which is effective but ......

"Despite these discoveries, many patients with BPD still feel they are dismissed as manipulative and beyond help. Challenging behaviours such as self-harming, which have been developed as coping strategies, are not always understood.

Many patients feel they have been written off by medics .......

There is no doubt that behaviours can be difficult but the NHS should be here to help those who suffer but, to its eternal shame, the NHS appears to shun the sufferers.

It will take time for old prejudices to fade and there is an ongoing issue with poor provision of psychological therapies.  Legislation and research alone cannot create the culture change the mental Welfare Commission and tens of thousands of sufferers would like to see.

In its quiet way this is about the most damning part of the article.

What oath have these medical oafs taken? It seems as though it must be along the lines of, "Now that I am qualified to practice I promise to uphold the traditions of medicine and be an arrogant and ignorant sod; I will treat my patients with the disdain in which the profession has always held the general public; my actions will always be in my best interests and rarely in those of my patients; any who question my diagnoses, judgments or opinions or those of my esteemed colleagues will be shunned until the sun stops shining out of my arse."

I'm sorry about my last paragraph.  I became angrier and angrier as I wrote this piece.  The Herald article in its understated style is a classic hatchet job.  My style - when angry -  is a touch less polished.